title: How important are venue-based HIV risks among male clients of female sex workers? A mixed methods analysis of the risk environment in nightlife venues in Tijuana, Mexico.
abstract: In 2008, 400 males ≥18 years old who paid or traded for sex with a female sex worker (FSW) in Tijuana, Mexico, in the past 4 months completed surveys and HIV/STI testing; 30 also completed qualitative interviews. To analyze environmental sources of HIV vulnerability among male clients of FSWs in Tijuana, we used mixed methods to investigate correlates of clients who met FSWs in nightlife venues and clients' perspectives on venue-based HIV risk. Logistic regression identified micro-level correlates of meeting FSWs in nightlife venues, which were triangulated with clients' narratives regarding macro-level influences. In a multivariate model, offering increased pay for unprotected sex and binge drinking were micro-level factors that were independently associated with meeting FSWs in nightlife venues versus other places. In qualitative interviews, clients characterized nightlife venues as high risk due to the following macro-level features: social norms dictating heavy alcohol consumption; economic exploitation by establishment owners; and poor enforcement of sex work regulations in nightlife venues. Structural interventions in nightlife venues are needed to address venue-based risks.
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California at San Diego, La Jolla, CA, USA.
authors.forename: Shira M
authors.initials: SM
authors.lastname: Goldenberg
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Manuel
authors.initials: M
authors.lastname: Gallardo
authors.forename: Lucie
authors.initials: L
authors.lastname: Nguyen
authors.forename: Remedios
authors.initials: R
authors.lastname: Lozada
authors.forename: Shirley J
authors.initials: SJ
authors.lastname: Semple
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000209:etiology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008800:Mexico; D018570:Risk Assessment / Q000379:methods; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000209:etiology; D055815:Young Adult